“Learning by Doing”—Resident Perspectives on Devel

Authors: S Ryan Greysen Danise Schiliro Leslie Curry Elizabeth H Bradley Leora I Horwitz

Publish Date: 2012/05/08

Volume: 27, Issue: 9, Pages: 1188-1194

PDF Link

Abstract

We conducted indepth inperson interviews with housestaff physicians with qualitative analysis by a multidisciplinary team using the constant comparative method to explore learning about highquality discharge care as a systemsbased practice and to identify opportunities to improve training around these conceptsWe analyzed interview transcripts from 29 internal medicine residents 17 59  were interns PGY2 or PGY3 12 41  seniors and 17 59  were female We identified a recurrent theme of lack of formal training about the discharge process substantial peertopeer instruction and “learning by doing” on the wards Within this theme we identified five specific concepts related to systemsbased practice and highquality discharge care which residents learned during residency 1 teamwork and the interdisciplinary nature of discharge planning 2 advanced planning strategies to anticipate challenges in the discharge process 3 patient safety and the concept of a “safe discharge” 4 patient continuity of care and learning from postdischarge outcomes and 5 documentation of discharge plans as a valuable skillDischarge care is an overlooked opportunity to teach concepts of systemsbased practice explicitly as learning about discharge care is unstructured and individual experiences may vary considerably Educational interventions to standardize learning about discharge care may improve the development of systemsbased practice during residency and help improve the overall quality of discharge care at teaching hospitalsThe authors would like to thank the Robert Wood Johnson Foundation RWJF Clinical Scholars program and US Department of Veterans Affairs VA for funding support Dr Horwitz is supported by the National Institute on Aging K08 AG038336 and by the American Federation for Aging Research through the Paul B Beeson Career Development Award Program Dr Horwitz is also a Pepper Scholar with support from the Claude D Pepper Older Americans Independence Center at Yale University School of Medicine P30AG021342 NIH/NIANo funding source had any role in the study design in the collection analysis and interpretation of data in the writing of the report or in the decision to submit the article for publication The content is solely the responsibility of the authors and does not necessarily represent the official views of RWJF VA the National Institute on Aging the National Institutes of Health or the American Federation for Aging Research

Keywords: